Insurers mum about implications
Insurers seemed reluctant Thursday to discuss problems at the Endoscopy Center of Southern Nevada. Just one major local insurance company — Sierra Health Services — responded to questions.
Many of Southern Nevada’s biggest insurers cover care at the Endoscopy Center. UnitedHealth Group’s Sierra Health and PacifiCare subsidiaries reimburse for procedures at the center, as do WellPoint’s Anthem plan, Aetna, NevadaCare and Health Alliance. But the insurers also pay for endoscopies at other facilities, so patients often have a choice.
Sierra Health, with about 650,000 customers, is Southern Nevada’s largest managed-care insurer. Sierra Health’s preferred provider for gastroenterology services is the company’s own Southwest Medical Associates, as well as its Southwest Surgery Center. But the insurer does refer “overflow” cases to the Endoscopy Center of Southern Nevada, spokeswoman Amanda Penn said.
Penn didn’t say Sierra Health had plans to stop sending patients to the Endoscopy Center. The center has taken corrective actions that the Southern Nevada Health District has accepted, and the center still has an active license to operate, she noted. Sierra Health hasn’t taken any action regarding the Endoscopy Center’s contract to provide care, but the insurer’s quality-assurance team will review the center, Penn said.
Sierra Health is formulating a “proactive” communications plan to reach out to clients who had procedures at the center, she added. The company will cover care for hepatitis infections no matter the source of the illness. And although Medicare announced plans last week to stop covering medical problems from hospital errors, Sierra Health has no policy in place to refuse error-related treatments or to recover the cost of caring for patients who got sick from poor practices at health centers.
Two local hospital groups said they don’t have agreements to send patients to the Endoscopy Center.
Hospitals within the Valley Health System and HCA Las Vegas have their own endoscopy units.
Gretchen Papez, a spokeswoman for Valley Health, said policy inside the company’s hospitals, which include Valley, Desert Springs, Summerlin, Centennial Hills and Spring Valley hospitals, is to use needles and syringes once.
That’s also standard procedure at HCA, which operates Sunrise, Sunrise Children’s, MountainView and Southern Hills hospitals, said spokeswoman Ashlee Seymour.
Contact reporter Jennifer Robison at jrobison@reviewjournal.com or (702) 380-4512.